I was recently listening to a talk by the Buddhist teacher James Low, which included an anecdote from his schooldays. Low was born in Scotland, in a time and place in which shipbuilding was still a major industry and so metal-work was taught in schools. On the first day in the metal-work class the teacher is introducing the lathes and explains that if he hits one of the children and they say “Ow!” he’ll stop, but that if they catch themselves in the lathe it won’t stop no matter how much they scream. Low was recounting this in the context of explaining the responsiveness of sentient beings but for me it brought to mind a long series of essays Paul Kingsnorth has been writing (starting here) exploring what he calls the ‘Machine’ and our relationship to it. Kingsnorth’s essays draw on a long tradition of thought that includes people like Jacques Ellul, Langdon Winner, Ivan Illich and most especially Lewis Mumford.
Lewis Mumford, (1895 – 1990) was an American historian, sociologist, philosopher, and literary critic who is perhaps best known for his work on the role of technology in society. In a famous 1964 essay Mumford outlined two distinct types of technology, or, to use his term, technics; these were democratic and authoritarian. The first tend to be relatively simple, to be locally controlled, to derive their power from humans or animals and to be adapted to local conditions. By contrast authoritarian technics are complex, situate control in the hands of distant elites, require the harnessing of large amounts of power and alter local conditions to better suit their needs and application. This description of authoritarian technics might bring to mind the smartphone in your pocket but Mumford actually situates their emergence with the pyramid builders of ancient Egypt. What he saw was that in order to build the pyramids tens of thousands of men were gathered together and organised by a controlling bureaucracy in such a way that they effectively constituted a machine comprised of replaceable parts. If for Mumford this represented the emergence of the ‘Machine’ the modern world of the twentieth century was characterised by the ‘Megamachine’: the convergence of science, economy, technics and political power as a unified force shaping society.
I think at this point in time it would be pretty hard to argue that Mumford’s characterisation of our world is incorrect. Just look at the number of billionaires, especially tech billionaires, flying in to attend and have their voices heard at COP26. For some the rise and increasing dominance of the Megamachine is seen as a positive thing for humanity. In his book ‘What Technology Wants’ Kevin Kelly, co-founder of Wired, uses the term ‘The Technium’ to describe "the greater, global, massively interconnected system of technology vibrating around us", a description that seems to mirror that of Mumford’s Megamachine. For Kelly the Technium is now so developed that it’s acquired a life of its own, become an evolutionary force with which we are now so enmeshed that attempting to extract ourselves from it would be futile and possibly self-destructive. Kelly notes that the rise of the Technium does involve the ‘erosion of the traditional self’ and that the advance of the machine and our increasing dependence upon it ‘chips away at human dignity.’ He balances this against what he sees as a ‘liberation’ that will offer ‘increasing the options, choices and possibilities’ to all living things.
Personally I’m more than a little sceptical about such claims. Given that our current predicaments; climate change, a mass extinction event, resource depletion, etc seem simply to be the unforeseen consequence of the operations of the technium/megamachine, the idea that the technium will increase the “options, choices and possibilities” of all living beings seems analogous to claiming that had the application of communism in Stalin’s Russia been a little more rigorous all would have been well. And there is some evidence to support such a view. In his book ‘The Struggle for a Human Future’ the philosopher Jeremy Naydler devotes a chapter to looking at the possible effects that micrometer radiation from 5G networks may have on insects, showing how honey bees heat up dangerously in the presence of such radiation. And even before 5G becomes widespread there’s growing evidence that electromagnetic radiation is already impacting insect populations. Such views are often viewed as being neo-luddite in character; in some way anti-progress and so anti-human. However it’s worth noting that the Luddites are commonly misrepresented as simply being anti-technology. A fairer presentation might be that they were for protecting their way of life, livelihoods and societal relations. Rather than being anti-technology they were, to use Mumford’s terms, in favour of democratic technics and opposed to authoritarian ones.
Before I come to the question of medicine I want to discuss one further strand of Mumford’s thought, that of the ‘magnificent bribe’. For Mumford the surrender of individual autonomy in the service of the megamachine was quite understandable in the case of the pyramid builders. They were slaves! It was harder to explain why members of Western democratic
nations might sacrifice such autonomy and Mumford’s answer was the magnificent bribe. In positing this Mumford acknowledges the great material wealth and comfort that the megamachine has produced and suggests we are all bribed with a portion of that plenty, giving up some autonomy in return. The rider to this, he suggests, is that we can only ever ask for that which the machine is able to offer, that our freedom is constrained within limits set by the machine itself. Is this a bad bargain? Perhaps each of us must answer that for ourselves but before we do so we should be sure we understand the full extent of the possible implications.
If we took the smartphone on which you may be reading this as an exemplar of the bargain we might start by looking at just how much of our time it eats relative to the convenience it offers us. We could then consider how we trade away a large amount of personal information in order to purchase that convenience. A subject Shoshan Zuboff has written about convincingly and at length in her book about surveillance capitalism. And most people have heard of China’s ‘Social Credit’ system, although might be less aware of how the sort of data our phones collect is being used to shape access to services in apparently democratic countries. There were also the revelations from Edward Snowden about how security services across the world are collecting huge amounts of data relating to their citizens.
Beyond that would you desire the convenience your phone offered if you had to live with the pollution created by the processing of the rare earth metals that make smartphones possible, or indeed if it was your children mining the cobalt.
What many of these ‘costs’ have in common is that we’re barely aware of them, their impacts aren’t felt by us immediately either in time or space. And this isn’t an accident. Google is happy to tell you about the convenience of having Google maps on your phone for free but doesn’t tell you that it’s selling to the highest bidder data about what you searched for in a given location at a given time. What this means is that we’re entering into a bargain less than fully informed about its nature. But there’s more to this bargain because in taking it we directly shape the future choices that will be open to us.
Anyone starting a small business today would be advised to set up a website, to advertise a phone number on that website and possibly develop a social media presence. How else will customers find you? Even twenty years ago a website might not have been necessary and Facebook didn’t even exist. Now the convenience of an always on internet and the ubiquity of smartphones means small business owners know customers expect a speedy response to enquiries. Not offering it might be difference between success and failure, or so we are led to believe. But have you ever tried contacting the customer service department of Amazon, or Facebook, or some other large tech platform? They make it incredibly hard to actually talk to someone, and if you can talk to someone the help they’ll offer will be limited to whatever the screen they’re looking at offers. They are not autonomous agents. Mumford’s observation that authoritarian technics reshape the environment in order to suit their needs is plainly visible here. These tech companies have so altered the environment within which we work, taken such a central role within it, that we need them more than they need us and so their customer service departments have withered and human agency has been removed. How should we factor such considerations into our acquiescence in the magnificent bribe?
I now want to turn this discussion to medicine because modern medicine fulfils Mumford’s description of an authoritarian technic and I’m interested by what this might mean for how we care for and treat illness. From what I’ve already said you’d be right to infer that I’m uneasy about the world the bribe has ushered us into but I’m writing what follows without preconception because this isn’t a subject I’ve ever really thought about before. So where to start?
I think I started thinking about all this when I read that the NHS was spending £248 million on technology to improve diagnostics and was planning to use AI (artificial intelligence) to improve health outcomes for ethnic minority patients. The key to all this seems to be patient data and there was a plan to share patient data gathered by GPs with unnamed third parties in the wider healthcare industry (but so many people opted out that the plan had to be put on hold). And there may well be real benefits; for instance its been suggested that AI powered image recognition software may be better at detecting cancer in mammograms
although this idea is disputed. What’s striking to me is how focussed care providers are on the intersection between the digitisation of services and the data of service users. Whatever the benefits, the business model seems remarkably similar to that of say Google or Facebook – digitise something that was previously analogue, and then gather and sell the data of those using the service. I can’t find who first observed that, ‘If you are not paying for it, you're not the customer; you're the product,’ but I wonder if that’s where healthcare in the UK is headed. Is that how the NHS will maintain a service that’s free at the point of need?
As I’ve read more about this area of medical research one of the things that struck me is how often these developments are talked about in terms of the ‘productivity and the efficiency of care delivery’. This is the language of the factory, of the machine. Nowhere in what I’ve read has the question of whether these are the values we’d collectively like our healthcare built around been asked. The closest might have been a short sentence in a report by the consulting firm McKinsey that mentioned in passing the ethical questions raised by the collection of significant quantities of medical data, before noting this isn’t an aspect of this ‘complex issue’ it’s planning to address. There’s no suggestion that there’s any reason we should progress carefully rather the report focuses on ‘what will enable innovation [today] and adoption tomorrow’, imagining ‘a future in which population-level data from wearables and implants change our understanding of human biology’. This is exactly the sort of thing espoused by futurists like Kevin Kelly and Ray Kurzweil. Kurzweil has suggested that in future everyone will live forever, that by 2030 medical advances will be adding at least one year of life expectancy per year thereby allowing us to outrun our own deaths. Not only are these medical technologies talked about using language full of mechanistic metaphors but patients are talked about in very similar ways.
Writing in Forbes in 2020 Rob Toews writes gushingly about the prospects for AI to transform healthcare. For Toews, a venture capitalist specializing in AI, ‘Machine learning and healthcare are in many respects uniquely well-suited for one another’ because a ‘healthy human body and its various subsystems function in consistent, quantifiable ways’ and so a ‘constellation of data points… tells the definitive story of a person’s health.’ On one level this may be true but the passage brings to my mind a mechanic plugging his diagnostic computer into my car when I take it to the garage. If I really can be reduced to a ‘constellation of data points’, a constellation that AI can find repeated across the population, then what am I and what are the implications of that? Am I simply another replaceable part of the ‘Megamachine’? And this brings me back to Mumford’s ‘magnificent bribe’; what are we being offered and what might the costs be?
What we seem to being offered is really very simple: longer, possibly infinitely longer, life, lived with less illness and pain and who doesn’t want that! Spelled out like that it’s a very hard proposition to object to. If I was sat here with arthritis in my hands such that typing was agony what would I offer to be free of that pain? Perhaps that’s an impossible question to answer. And perhaps if I really could be plugged into a diagnostic machine far an annual MOT the arthritis would be detected so early that it could be treated long before it ever became a problem (assuming it can be treated). This at least is the promise.
One of Mumford’s observations is that once one has taken the ‘magnificent bribe’ no other choice is possible. With that in mind I want to take some of the wilder claims made by Kurzweil, take them to their logical conclusion and see what that looks like. What would a potentially infinitely long life, lived in good health, with parts replaced as necessary really look like? The first thing that springs to mind is to ask what the point of children would be in such a world? Would we need children? And what about human population, which is probably already past a level the planet can support. How would endlessly postponing death impact on that? And if we did have an endless future how long would it be before we got bored and what would we do then? Would such people opt for voluntary euthanasia or just keep postponing death in the hope of finding some new thing of interest.
Perhaps all that is a little far-fetched and more immediately it makes sense to ask if the future these people imagine is one in which all people are going to share in? To me this feels like Elon Musk suggesting that the future of humanity lies on Mars. Well I don’t know about you but I’ve not had my invitation yet and I’m coming to suspect that’s a future most of us will never be invited to. But without imagining a far future there are already those seeking endless youth right now. There’s a booming market in ‘young blood’ taken from youthful donors and then transfused into older (wealthy) recipients who hope for health benefits from the youthful blood. As far as I’m aware so long as the amount of blood taken isn’t excessive there are no immediate health impacts for donors (and possibly none for recipients either). The same can’t be said about the trade in human organs. There’s a thriving black market in human kidneys, often sold by poor individuals in third world countries as a way of raising money, these people are vulnerable to both coercion and theft, as well as to the health implications of surgery that may be carried out in less than ideal conditions with inadequate post-operative care (see also here ). What these two examples suggest is that the utopian future some imagine may well be purchased at the price of a dystopian future for others.
Perhaps a broader critique of this sort of thinking is that it assumes that the wider technological system on which modern medicine rests can be endlessly extended. But that may well be a mistaken assumption and indeed it may that very system that is increasingly
implicated in the some of the illness from which we now suffer. For instance scientists recently suggested that pervasive chemical pollution may have passed a safe limit for humanity, while the response to the Covid 19 pandemic has led to a huge increase in plastic pollution, particularly in poorer countries where its likely to be either burned in the open or end up in the ocean.
I’m not reaching any conclusion here and I’ve already noted how my own suffering or that of my loved ones would weigh heavily when choosing just what treatment I may or may not wish to accept. I guess the question I’m asking of myself is how does this relate to my work as an acupuncturist. In the context of the above perhaps the single biggest difference between acupuncture and western medicine is that acupuncture doesn’t imagine a future in which all illness is banished and death is overcome. Rather it sees death as an integral part of life and within that context aims to help each life to be as fully expressed as it can be. I was talking with my Tai-Chi teacher this morning about the concept of ‘Ming’. Ming is our life path, the path along which the energy of our life can flow most readily, along which we do our best work and engage most fully with those we encounter. No one knows how long that path is but being upon it is more important than its length.